traumadreams

In order for your body to reach the high temp of a fever (or malignant hyperthermia), it requires increased metabolic demands. In other words you body requires fuel and wood to keep that "fire" going. Think of the oxygen as "fuel." Well, just like a fire eats up O2... so does your body when it increases its metabolic process to get its temp up. When your body requires more O2, it puts an increase demand on your heart. This is why tachycardia accompanies a fever. Your heart pumps faster to get more oxygen to the cells that are now burning fuel to maintain a high temp. By placing a pt on O2, you lower this demand and "help out" the heart. You use a non-rebreather, because it is the only mask that can deliver 100% O2 (or pretty darn close- I've heard that no mask can actually deliver 100%). So... -High Temp = increase metabolic demand -Increase metabolic demand = I want more oxygen (cells need fuel) -Heart speeds up to meet this increase demand of oxygen -Non rebreather at 15 LPM provides extra O2 -Heart now has back up!! Cells get their fuel!! Hope this helps.

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Oh my gosh, thank you for the reply!!! Your reassuring words gave me a boost! Yey! I will get on it!

I did hurst online and live.... I thought it was fantastic. I did the live review one month before my test and then spent the 4 weeks prior going over and over the online one till I could almost say it all on my own... Lol. Passed the first time! Good luck!

Hello New Yorkers! My husband will be transferring from San Antonio, TX to NYC in early 2015. I'm excited about the big move and I am starting to attempt to line up my ducks, but I could use some help! First, how is the job market out there? I am a BSN-RN and have been nursing for 3 yrs with the last year spent at a level 1 trauma center ER. By the time we move, I will be TNCC, ENPC, and CEN certified. Any advice where to start? What hospitals ERs are hiring?? Second, how long does it take to get my NY license... And what are the steps? I went on the nyed website and it seems a little confusing. I will appreciate any and all advice! Thanks!

OP, I had to take the first job offer when I became a new nurse, even if it wasn't what I wanted. Just find whatever you can. Are you in touch with people from nursing school? The best way to get into a job is to have someone you know get you in. Also where did you do clinicals? Try to contact the floor managers where you did them. Just look for anything! I know a new grad that got hired as a part-time school nurse- she did that for a couple months and it was enough for her to move into a tele unit! Good luck! Don't give up!

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http://www.ahrq.gov/professionals/systems/hospital/esi/index.html This is a link for the ESI handbook. You can download it from here and also check out the algorithm, it involves VS!!! You can't place an ESI without Vitals!!! Hope this help!

It depends on the facility... Really it does! I work at a level 1 trauma center and our pit boss in trauma is a PA. All our providers (mid level, physician, resident) are assigned in teams and they rotate throughout the different areas (trauma, general, medical resuscitation, psych, urgent care, triage). The team will usually consist of 1 attending, 1 resident, 1 midlevel (NP or PA) and stragglers (whatever medical student, pa student, first year resident is doing their rotation). I have seen everyone in every area... We only have one acute care NP and she has intubated, PA's intubate, residents intubate.... Heck.... Intubations all around! Except for the FNP's... but they're not trained to do that. Hope this helps!

I transferred to ER from the floor last December and here's what I've found: There is no set pattern in the ER. You have no clue how many patients you will see ,total, in a day... You may turn over your entire assignment multiple times or just once or twice... You never know! And how can you predict how many MVC's you'll have??? No way! The ER... you never know whatcha gonna get! You don't know the patients! On the floor, you've gotten report, you've had the pt for a couple of shifts, you get to know them (how they react to meds, preferences, medical history, med allergies, etc). In the ER, sometimes they arrive unconscious... Well, are they allergic to the levophed you're about to start???? You don't develop that lasting relationship with the pt (I have found that I like this part of the ER, you might find it the other way around). For the most part, you get the pt, you stabilize them, they move out! What was their name again? I think I'll take my lunch at 1230 today.... Wrong!!! Bus rollover! It's 1500 and the cafeteria closed! You don't get that 0900 Medication 100k Dash... You give meds as pts come in... Usually they stagger in... Isn't that nice? ~also you usually don't have to worry about their 27 home meds in the ER Medicine Mondays!!!!!! Trust me, it's a thing. Also, depending on your hospital... You might get to know your homeless population very well! They come and sign in, chit chat, get some food and what not.... I know most of them by name now! "Hi, nurse Becky? This is you public health nurse. You know that pt with a mild cough you had last week for 8 hours in that teenie-tiny little room???? Ding ding ding!!!! TB!!! Come on down and get your free PPD!" And the biggest difference to me is that, on the floor, you know what's wrong with them. You have a diagnoses to battle with. CHF Exacerbation, pneumonia, asthma, COPD, Bronchitis, Atelectasis, pleural effusions, they all look pretty similar without their fancy title!! Which one does this stranger walking in with SOB have? Spend a day or two down there... If you think you have what it takes, I'm sure you friendly ER will be happy to have the extra set of hands! Good luck!

Wow! I have never heard of a system like this one. This sounds really unsafe! I'm constantly worried about my license at our triage due to lack of beds and long wait times (18+ hrs) but yours sounds like a lawsuit waiting to happen! No protocol orders? No vitals? Consider very carefully about staying here... In my experience, the front door practices set the example for the rest of facility. If this is their standard of practice right from the get go, I would be worried about the rest... Good luck